Provider Demographics
NPI:1336924042
Name:POSITIVE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:POSITIVE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:402-660-4897
Mailing Address - Street 1:83313 508TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:NE
Mailing Address - Zip Code:68622-3042
Mailing Address - Country:US
Mailing Address - Phone:402-660-4897
Mailing Address - Fax:
Practice Address - Street 1:1900 VICKI LN STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4558
Practice Address - Country:US
Practice Address - Phone:402-660-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty